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ImagingSession Title: Echocardiography/Imaging in Structural Heart Disease and Interventions I

Abstract 16509: Characterization of Left Ventricular Mass Regression and Left Ventricular Mechanics After Aortic Valve Replacement: Comparison Between Aortic Stenosis and Aortic Regurgitation

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Abstract

Background: Severe aortic stenosis (AS) induces different left ventricular (LV) remodelling than severe aortic regurgitation (AR): concentric hypertrophy in pressure overload (AS) and eccentric remodelling in pressure and volume overload (AR). Little is known about LV remodelling after aortic valve replacement (AVR) and its consequences on LV mechanics in AS versus AR.

Purpose: To describe changes in LV mechanics (characterized by global longitudinal strain [GLS]) and LV mass over time after AVR in severe AS and AR patients, both with preserved LV ejection fraction (EF).

Methods: A total of 165 patients (63 with severe AR and 102 with severe AS; mean age 61±13 years and 39% female) who underwent AVR with routine echocardiographic follow-up (median 4.7 years) were evaluated. LV mass index (LVMI) and LV GLS were assessed on transthoracic echocardiography.

Results: At baseline, patients with AR had more eccentric LV remodelling with larger LVMI compared with AS patients (154±42 g/m2 vs. 132±37 g/m2, respectively). This difference was not statistically significant after correcting for age, gender and LV end-diastolic diameter (p=0.75). On adjusted analysis, LV GLS was significantly different between the two groups (AR: -15.3±4% vs. AS: -14.7±4%, p=0.018). At follow-up after AVR, there was significant regression in LV mass during the first year which was sustained thereafter in the overall population (Figure panel A). LV GLS improved significantly after 1 year of follow-up in the overall population (Figure panel B). These changes were comparable for both AS and AR.

Conclusion: After AVR, there is a significant improvement in LVMI and GLS over time in both AS and AR patients with preserved LVEF. Furthermore, no differences in the time course of LV mechanics or LV mass regression were observed between AS and AR. While regression of LV mass occurs during the first year, GLS improves after the second year of follow-up.